Why Did He Cut Off That Man's Leg?

Twenty-five years ago, when I was a junior reporter and stringer for the San Francisco bureau of Time magazine, I came across the greatest story I never wrote, which was actually a pretty smart decision at the time, given that the story had no ending, I didnt know how to write such a story then, and even if I had written it, Time wouldnt have run it. It wasnt merely that the story was too bizarre. Time was a news magazine, and this wasnt news. It was, rather, a glimpse into the darker corners of the human spirit, the kind of thing you naturally gravitate to late in the evening, when, tired of films and politics, youd say to your friends, "Do you want to hear something really sick?" And thered be a silent, collective "ahhh," like that of children snuggling in for a bedtime story, knowing they were about to hear what theyd been waiting for all night.

I first came across the name John Ronald Brown in the late fall of 1973 in the San Francisco Chronicle when I saw an item in Herb Caens column about a doctor down on Lombard Street who was "lopping" peoples penises off. As it was my (self-appointed) job for Time in those days to cover the more raggedy edges of the ongoing paradigm shift, I called up the clinic and found myself talking to Browns partner at the time, Dr. James Spence, who, despite some reservations, invited me to see him.

Spence struck me as a bit of a hustler, far less polished than one would expect of someone with a medical degree  if he had a medical degree. To some people he gave business cards reading "Dr. James Spence." But to me he said hed earned his medical degree in Africa and thus couldnt practice here. (I later heard he was an ex-con who claimed to be a veterinarian, but that degree was phony, too.)

The clinic wasnt much  just a few rooms on a busy street, it seemed more like a real estate office than anything else. Sensing my skepticism, perhaps, Spence invited me to an upcoming formal dinner at his hilltop home in Burlingame, where he and his partner, the renowned plastic surgeon Dr. John Ronald Brown, would be explaining his new operation to a group of urologists, proctologists and internists, some of whom, Spence hoped, would join him and Dr. Brown in setting up the finest sex-change facility anywhere in the country.

A week later, I drove to Burlingame and discovered that Spence had a splendid home  if it was his home  overlooking the distant San Francisco Airport and, beyond, the bay. It was a surreal evening. Dinner was served by half a dozen attentive transsexuals who were undergoing hormone therapy while awaiting surgery.

At first, the other doctors seemed quite intrigued by Spences proposal for a full-service sex-change clinic. I remember sitting at one end of a long dinner table, watching Spence cut up a pear with a pocket knife while another doctor earnestly asked how he would select candidates for surgery. "It takes one to know one," Spence told his startled guests. "We let other transsexuals make the decision. They can tell best when someone is a true transsexual  a woman trapped in a mans body."

After the fruit and cheese, we adjourned to the kitchen, where one of the waitresses lay back on a butcher-block table and casually flipped up her skirt. A gooseneck lamp was produced, and all the doctors proceeded to examine the kind of work currently being done by Dr. Browns competition.

Im no expert in female anatomy, but the waitresss genitalia didnt look like those of any woman Id ever seen. There was no clitoris or anything resembling a vagina. It rather looked like someone had taken a pickax and neatly poked a small, square hole, an inch on a side, directly into her groin  either that or like an aerial photograph of a Manitoba iron-ore mine taken from 20,000 feet. In contrast, Spence maintained, Brown had developed a revolutionary technique that would give transsexuals fully orgasmic clitorises and aesthetically pleasing vaginas.

Later, Dr. Brown and I stood around the kitchen table while he displayed what to me were ghastly photographs of his surgical technique. One picture showed a gauze noose holding up the head of a bloody penis while Brown sliced away at the tendrils of unwanted erectile tissue (the capora cavernosa).

Unlike some other gender-reassignment surgeons, and contrary to what Herb Caen had written, Brown didnt exactly lop off the penis. At least in later years (his process was continually evolving), he carefully split the penis, then, after saving the nerves and blood supply, positioned the glans penis under a fleshy hood to create the clitoris. With the leftover penile skin he made the labia majora. Finally, after removing the fat and hair follicles, he used the scrotal skin as lining for the new vagina.

As a layman, I couldnt tell if Brown was a competent surgeon or not, but I must say he came across as genial, knowledgeable and obviously quite proud of his ã technique. There was a certain naiveté (and even passivity) about him that struck me as surprising in a surgeon, but compared to everything else Id seen that night it didnt warrant a second thought.

Since this was hardly a story I could write for Time, I produced an appropriately dull and thoroughly bloodless article about the growing phenomenon of sexual-reassignment surgery: "Though the first modern medically supervised sex-change operation took place in Europe in 1930, transsexual surgery did not attract wide notice until the transformation of a former GI named George Jorgensen to Christine in 1952 . . ."

A month later, in early January 1974, just as my story was about to appear in print, Brown called in a near panic to beg that I not mention his name. The proposed new clinic had fallen through, and Spence, he said, was now saying all sorts of terrible things about him. As my story didnt mention Brown (or anything else about that night), I told him to relax. That was the last I heard of him until early this October, when I clicked on the Internet and the following story caught my eye:

SAN DIEGO  A 77-year-old former doctor has been convicted of murder for fatally botching the surgery of a New York man who wanted his healthy leg amputated to satisfy a bizarre fetish.

The story gave the name of the fetish as apotemnophilia  "sexual gratification from limb removal." It said that "only 200 worldwide are known to suffer the fetish." It reported that the victim, 79-year-old Philip Bondy, had paid $10,000 for the operation, after which he died in a "suburban San Diego hotel" from "gangrene poisoning." It said that the unlicensed doctor who performed the surgery could get "life imprisonment for second-degree murder." Although the story gave the doctors name as John Ronald Brown, at first it didnt ring a bell. But after downloading additional stories, I found myself looking at a photograph of a heavyset, pink-complexioned man with thinning, disheveled hair, and suddenly I realized, Hey, I know this man.

Driving up to San Diego Countys George F. Bailey Detention Center, I feel as if Im visiting some remote outpost in the mountains of Mars. The detention center is located on a desolate brown hilltop two miles north of the border with Mexico; off in the distance I can faintly see Tijuana, shimmering in the heat and haze. There are no people, no birds and no wind. Two faded flags hang limply outside the visitor entrance, which is landscaped with cactus and crowned with long coils of razor wire.

Because Brown is staying in the jails medical wing (hes diabetic), hes wearing what looks like a surgeons standard blue operating smock (the difference is that his is splattered with fat gravy stains). Although cordial and deferential as we talk by phone through the wire-reinforced windows, Brown at times seems anguished, or at the very least distracted, gnawing on his fingernails or swirling his tongue around the corners of his mouth. Sometimes, he turns sideways and lets me talk to his profile while he leans wearily against the concrete wall.

Although I find it hard to hear Brown (a man in the adjacent visitors chair is reading religious tracts into the phone), eventually Im able to get to the heart of the matter: Why, against state law, the Hippocratic oath and, in my opinion, basic common sense, did he cut off that mans leg?

Brown replies that he was simply doing what doctors are supposed to do  meet the patients needs. "In cosmetic surgery we do things all the time for which there is no need. We are constantly rearranging what God gave us."

"But what about your own liability?" I ask. The patient, I point out, was a frail old man, still recovering from pneumonia, with a history of heart disease and bypass surgery. Even in ideal circumstances, his post-operative prospects were far from great. "Werent you worried that people would ask questions if he died?"

Brown shrugs. "I didnt spend much time thinking about it," he says.

Someone who did think about it was Gary Stovall, a homicide detective for the San Diego suburb of National City, who on May 11, 1998, was assigned to investigate the death of an elderly New York City resident found in Room 609 of the local Holiday Inn with his left leg missing and blood oozing from the stump.

Despite the bizarre circumstances, at first it wasnt completely clear to Stovall that a crime had been committed. A friend of Philip Bondys had initially told the police that Bondy had been in a "taxi accident" in Mexico and had required immediate surgery in a clinic there.

But to Stovall that story didnt make sense. If Bondy had been in an accident, why didnt his body have any other injuries? If an American citizen had been badly injured in a traffic accident, why didnt the Tijuana police know anything about it? And strangest of all, why did Bondy have two $5,000 receipts in his room, one for "surgery" and the other for "hospitalization," both signed by a local man named John Brown?

Because Stovall was working on another murder case at the time, he couldnt immediately go see Brown in person. And besides, says Stovall, a baby-cheeked detective with a deceptively mild manner, "I was still under the impression that he was a good Samaritan."

But when Brown still hadnt returned any of Stovalls three phone messages by Wednesday morning, May 20, Stovall drove to Browns San Ysidro apartment and ã banged on the door.

"Do you know why Im here?" he asked.

"Yes," answered Brown, who had come to the door wearing a robe. "Its because of the man who died in the hotel room in National City."

Although Brown was "nonthreatening, polite, well-spoken and obviously well-educated," says Stovall, it was also clear to him that Brown was not someone for whom "personal appearance was a high priority." When Stovall asked him to come down to the station, he put on a wrinkled shirt and a stained jacket. Not only did his apartment smell like "garbage," but the couch was bloodstained and the stuffing was falling out. The stove was "filthy" and the sink was stacked with dirty dishes. There were books, professional journals, travel bags and medical supplies scattered about the floor. "If a child had been living there," Stovall says, "Id have put him in a foster home."

Brown declined to say whether or not hed amputated Bondys leg, says Stovall, but he talked about virtually everything else, including driving Bondy to the clinic and visiting him at the Holiday Inn the following day to inspect the wound. (He saw some "minor red marks," Brown tells me, and "possibly" a pale-blue tint, indicative of emerging gangrene.)

At first Brown didnt want to make a statement, says Stovall. "Then he said, Okay, Ill make a little statement. He ended up making a 29-page statement." Although Stovall still didnt know what had happened to Bondy, he was convinced that something illegal was going on. After 90 minutes, he left the interview room to tell his superiors that he was going to arrest Brown.

Brown, who tends to be oblivious to the psychic atmosphere, didnt even realize that he was in trouble. After waiting 45 minutes for Stovall to return, he says, he was bored and restless  "There was nothing to read." Deciding he had better things to do, he walked out of the station and headed home. He had gone two blocks and just turned a corner, he says, when suddenly two police cars and what seemed like 12 officers appeared.

It reminded Brown of the "Toonerville cops." Then, he says, "one pulled out a gun and pointed it at my head." Brown looked at the weapon in astonishment. "All I could think," he says, "was What a fucking big gun!"

If the gun amazed Brown, his arraignment dumbfounded him. The prosecutor, Deputy District Attorney Stacy Running, asked the judge to hold him without bail on the grounds that he was an "incredibly dangerous individual to the citizens both of the United States and Mexico."

To Brown, none of this made sense, either legally or morally. "I didnt think any laws had been violated on either side of the border," he says. "Or, from now on, is every surgeon who performs an operation where the patient later dies of infection going to be arrested for murder?"

Friends and former patients were outraged as well. It wasnt Browns fault that Philip Bondy died, says Ann, whose sex-change surgery was a great success (but who asked to be identified only by her first name). "That old man was already sick. He just wanted his leg cut off so he could get a hard-on. Dr. Brown was just doing his job."

To Browns ex-wife, Julie, and their two teenage sons, his arrest came as a devastating shock. "My oldest boy was going to spend the day [with him]," says Julie, a hearty, buoyant woman who has remained on close terms with Brown. "He called over there. Can I speak to my dad? The police said, Your dad has been arrested for murder."

As soon as the police finished searching Browns apartment  they took everything, including the garbage disposal, she says  they came over to search hers. "There were a bunch of guys in yellow jackets, like a SWAT team. They had a search warrant. They asked me to sit on the couch. The first thing they did was take pictures of my fish tank. I heard on the news that Brown had been arrested for cutting off the mans leg. What did they think  that I was keeping it in the fish tank?

"They were here for hours. They told me I was going to jail and that I would never see my kids again. I was crying. I begged them, I said, Please dont take my kids away. They said Brown bought me from my father. Did he pay for you? I said I wasnt a cow. Yes, it was an arranged marriage, but so what?"

Julie, a native of the Caribbean island of St. Lucia, met Brown in 1981, when he opened a practice there. "He asked me if I would like to get married," she says. "I said, I dont know. I was 17. He was 59."

Although the two were divorced in the early 90s, after Brown was sent to prison for practicing medicine without a license, Julie says she still loves him. "He raised me. He taught me to read and write. Hes a really good man. If I had it to do again, Id marry him in a heartbeat."

One thing I quickly discover is that there appears to be no broad middle ground in peoples opinion of John Brown. Some former patients cant praise him highly enough. "He did exactly what I asked," says one young woman who asked Brown to increase her cup size from 34B to 36B. "He was always a gentleman, courteous, very considerate, thoughtful, intellectual and calm."

To old friend and longtime admirer Patrice Baxter, Brown was "one of the best surgeons in the United States." Not only did he do Baxters tummy tuck, face-lift and breast implants, he also did her granddaughters ears. "They stuck out. The kids on her track team called her Dumbo  Why dont you just fly? He did her nose, too." It turned out so well that she became a model.

At 66, Baxter has a trusting manner, pink, unblemished cheeks and, thanks to Brown, a generous uplifted bosom. She met Brown in Rosarito Beach in 1982, she tells me, and over the years he operated on so many of her friends and relatives that it became a running joke. One time when Brown was visiting Baxters home, she ran out of bedrooms. "So my girlfriend says, Well, he can sleep in my room. Hes seen everything Ive got. Then I said, Well, he can sleep in my room. Hes made everything Ive got."

Which isnt to say that Brown didnt have his faults, says Baxter. "He was brilliant, but he had no common sense. He would walk through plate-glass doors. He couldnt balance his checkbook." Sometimes in the middle of a conversation hed just pick up a magazine and begin to read. His bedside manner was no great shakes, either. "He tended to mumble. He didnt hold your hand."

But so what? she asks. "He wasnt a general practitioner," he was a surgeon. He certainly wasnt in it for the money. "He only charged $2,500 [for a sex change]. Half the time they didnt even pay."

In the last 25 years, according to Browns estimate, he did 600 male-to-female sex-change operations, most without benefit of a medical license. Even so, with at least some of them, the results could hardly have been better. One 33-year-old "manager for a major airline" tells me she had Brown do her gender- reassignment surgery in 1985, when she was only 19. It was so successful, she says, that when she later got married, her husband never guessed shed been a male. (To simulate a period, she used to prick her finger to leave bloodstains on the sheets.) I also hear from Ann, a Cambodian refugee whose father was killed by the Khmer Rouge, that Brown changed her entire "suffering, painful life" from that of "an ugly worm to a beautiful butterfly." Furthermore, unlike that of some transsexuals, who have difficulty passing as women, her surgery turned out so well, she says, that she got a job as a stripper in Las Vegas Chinatown.

At the same time, there are plenty of other people who tell me they wont rest until Brown is behind bars for life. UC San Diego plastic-surgery professor Jack Fisher has personally repaired 12 to 15 of what he calls Browns "pelvic disasters." "Hes a terrible, appalling technical surgeon," says Fisher. "Theres just no other way to describe it. He doesnt know how to make a straight incision. He doesnt know how to hold a knife. He has no regard for limiting blood loss." Basically, says Fisher, the man "had been committing crimes against humanity for years."

Dallas Denny, an Atlanta-based transgender author and activist who periodically posts warnings about Brown on the Internet, says that among transsexuals he was known as "Table Top Brown" for his willingness to operate in kitchens, garages and motel rooms. "Patients were waking up in parked cars or abandoned in hotel rooms. There was no screening and no aftercare. Anyone who walked in the room was a candidate."

And the results of the surgery, says Denny, were horrific. "Some of these people, expecting vaginoplasties, received simple penectomies, leaving them looking somewhat like a Barbie doll," she wrote in a 1995 attack on Browns skills. "Others ended up with something which looked like a penis which had been split and sewn to their groin  which is essentially what had been done. Some ended up with vaginas which were lined with hair-bearing scrotal skin; these vaginas quickly filled up with pubic hair, becoming inflamed and infected. Some ended up with peritonitis, some with permanent colostomies. Some ran out of money and were dumped in back alleys and parking lots to live or die."

Cheree, a northern California businesswoman, went to Mexico in 1984 to have dual sexual-reassignment surgery with her brother at Browns Tijuana clinic. "He ran specials  bring a girlfriend, two for the price of one." But after Cheree saw the conditions there, she changed her mind. "The sewers overflowed once or twice a day." There was never enough running water or enough bathrooms. The operating room was just an ordinary bedroom with an ob-gyn chair. Sometimes, says Cheree, "Brown would sip coffee while doing the operation."

But the thing that most bothered Cheree, she says, was Browns "brusque" attitude. After surgery, he would grab the dried, blood-clotted bandages and rip them right off. He was always so disheveled, too. "His hair went in different directions. His shoes were scuffed and worn down. I remember him walking down the hall eating raw weenies right out of the package. A fucking package of weenies!"

In one case, says Cheree, who spent 11 days at Browns clinic caring for her (new) sister, Brown operated on an HIV-positive patient who still had pins in her arm from an auto accident (she used the insurance settlement to pay for her surgery). In another, he used too much erectile tissue to construct genital outer lips. As a result, whenever the girl got excited "her labia got hard."

But despite Browns flaws, says Cheree, there was a reason why so many "girls" went to him  "He gives you a vagina at a fair price." Whereas with other doctors you had to take hormones, wait up to six years, live as a woman, undergo psychological evaluations and then pay $12,000 to $20,000 or more, with Brown it was good old-fashioned capitalistic cash-and-carry. Anyone, says Cheree, could ã raise the necessary $2,000 or $3,000 Brown used to charge (in the 80s) by turning "a couple of tricks." The word would go out that Brown was coming to town. "Hed shoot silicone anywhere you wanted it. For $200 hed do breast surgery. For $500 hed do cheeks, breasts and hips. After injections you had to lie flat on your back for three days so the silicone wouldnt go anywhere. He plugged the holes with Krazy Glue."

There wasnt any indication in Browns early years that hed one day end up as an itinerant peddler of silicone injections. The son of a Mormon physician, he found academics so easy that he graduated from high school before he turned 16. When he was drafted by the Army in World War II, he did so well on the General Classification Test (scoring higher, Brown says, than any of the previous 300,000 people who had gone through the Salt Lake Induction Center) that the Army pulled him out of the clerk-typist pool and sent him to medical school. He graduated from the University of Utah School of Medicine in August 1947. But after two decades as a general practitioner in California, Alaska, Hawaii and the Marshall Islands (and after nearly losing a patient when he got in over his head during a thyroidectomy), Brown decided he needed formal surgical training. He spent two years at Newark City Hospital as chief resident, he says. Later, he attended a program in plastic surgery at New Yorks Columbia-Presbyterian Hospital, but in what would become the first great professional disappointment of his life, he was never able to achieve certification by the American Board of Plastic Surgery (and with it staff privileges at major hospitals).

"I passed the written part of the exam without cracking a book," he says. The problem was the orals. As a result of having grown up with a "domineering" father, he tended to fold when confronted by authority figures. "My brain turns to cottage cheese."

Ten years later, in 1977, in what was the second great disappointment of his life, the California Board of Medical Quality Assurance, in part as a result of his association with James Spence, revoked his medical license for "gross negligence, incompetence and practicing unprofessional medicine in a manner which involved moral turpitude." Among other things, the board charged, Brown allowed Spence to hold himself out as an M.D.; he allowed unlicensed people, including other transsexual patients, to write prescriptions under his signature, diagnose patients and provide medical care; he misrepresented sex-change surgery on insurance forms as corrective surgery for "the congenital absence of a vagina"; he exhibited "gross negligence" by failing to perform sex-change operations in an acute-care facility (Brown did them in his office on an outpatient basis); he unaccountably failed to hospitalize a patient who had a "life-endangering" and "pus-infected" wound the size of a softball where his penis used to be; he failed to take medical histories or do physical exams before surgery; and he did sex-change surgery on virtually anyone who asked for it, regardless of whether they were physically or emotionally stable enough to cope with it.

Despite the medical boards harsh denunciation of Brown, the administrative judge who recommended that his license be revoked apparently did so reluctantly, as he also filed a "memorandum opinion" on Browns behalf, pointing out that the doctor, despite his "difficulties," appeared to be "a pioneer" who made "innovative contributions" to the emerging field of transsexual surgery. Perhaps a better resolution to the problem, wrote Judge Paul J. Doyle, would have been to limit Brown to doing surgery in a "medically recognized organization," while denying him any responsibility either for determining the eligibility of prospective patients or for their post-operative care.

Most doctors, when they have their licenses revoked, give up, leave the country or find another line of work. At first Brown did try to work outside the continental United States. But after successively losing permission to practice in Hawaii, Alaska and the island of St. Lucia ("I dont know what you have to do to lose your license in the Caribbean," says UCSDs Jack Fisher), Brown returned to Southern California, where he started what would eventually become an ambitious underground practice in gender-reassignment surgery, breast implants, face-lifts, liposuction, ã silicone injections, penile implants and penile enlargement. To avoid legal problems, he lived in Chula Vista but did his surgery in Mexico. (In his advertising brochures, Brown referred to this as his "international practice.")

In 1986, Penthouse Forum magazine sent a writer to Tijuana to investigate Browns claim that he could make penises an inch or two longer by cutting the suspensor ligament holding the penis root to the pubic bone. The article, published as "The Incredible Dick Doctor," portrayed Brown as a wildly inattentive driver who backed into other cars, an absent-minded dresser whose pants fell down in the operating room, and a blithe spirit of a surgeon who, when he accidentally made a cut in the penile shaft that sent blood spurting everywhere, casually declared, "I made a boo-boo."

A few years later, the television news magazine Inside Edition followed up on the Forum piece with an investigative story on "The Worst Doctor in America." In it, Brown, who apparently gave the camera crew free run of his clinic, is shown performing a scalp-flap operation to give a transsexual a more feminine hairline. Although the patient is supposedly under deep sedation, he moans and howls all through the procedure, a development Brown dismisses on camera as "nothing unusual."

It seemed unusual enough to the San Diego District Attorneys Office, however, that it launched an investigation that led to Browns spending 19 months in jail for practicing medicine without a license (hed previously been convicted of prescribing narcotics after his license had been revoked and practicing under a false name). The jail term didnt deter Brown. Hed decided to become a "rebel" long before. "I didnt like some of the things that organized doctors were doing, so I rebelled," he says. "Later I didnt like what the government was doing in support of the medical organizations, so I rebelled. I chose to ignore the laws." As soon as he could pull things together (he had to drive a taxi on Coronado Island for a year), he resumed his surgical practice, doing operations in Tijuana and living now in San Ysidro. It was there, in 1996, that he got that first tentative call from a New York therapist and apotemnophiliac by the name of Gregg Furth.

Furth was a Jungian analyst who in 1988 had published a well-regarded and often-cited book, The Secret World of Drawings, which analyzed the artwork of children dying of leukemia for clues to their subconscious (many apparently knew exactly when they were going to die). A handsome, personable man around 50, he was good friends with a much older man, Philip Bondy, a retired Loral (satellite) Corp. engineer and fellow apotemnophiliac who liked to collect photographs, slides and videos of male amputees.

Despite his professional training (and years in analysis), Furth still had no idea where his and Bondys apotemnophilia came from. Although Johns Hopkins psychologist John Money, who originated the term, had argued that apotemnophilia was "conceptually related to transsexualism, bisexuality and Munchausens syndrome (feigning illness to get medical care)," Furth believed it had less to do with sex and more to do with possession by an alien limb.

"The way he explained it to me," says Deputy D.A. Stacy Running, "is that its as if Your leg is attached to my body, and once I get it off, my body is whole. You see me as being mutilated. I see myself as finally being whole. I live with it. I cant understand it. How the hell do I explain it to you?"

Officially classified as a "paraphilia" (extreme or atypical sexual behavior or desire), apotemnophilia can be irresistibly intense. Some apotemnophiliacs, when they cant find a doctor to do the surgery, resort to removing unwanted limbs with chain saws, shotguns, trains and, in one case, a homemade guillotine. Others spend their time looking for a surgeon who will take their desires seriously and not just patronize them with referrals to psychiatrists. In 1996, while passing through San Diego, Furth came across a newspaper article about John Ronald Brown, and suddenly he knew hed found the man for whom hed been searching his entire adult life  a competent "fringe" physician who wouldnt balk at cutting off a healthy leg.

Fearful that Brown would turn him down if he came right out and said he wanted his leg amputated  "I didnt want to hear no over the phone," Furth would later testify  he flew to San Diego to plead his case in person.

It wasnt a hard sell. Brown says he found Furth likable and persuasive, while Furth thought Brown uncommonly open-minded about a would-be amputees right to choose. Brown set the price of the procedure at $3,000, and in February 1997, Furth traveled to the Clinica Santa Isabel in Tijuana, where Brown did his surgery.

Unfortunately for Furth, Brown had neglected to tell the assisting doctor that theyd be cutting off a healthy leg. "He was Mexican, short and round," Furth testified. "He wanted to know what all this was about." When Furth told him, the doctor became enraged. "He kept saying, This isnt right! You dont want this!" Finally, he stormed out of the building, forcing Brown to cancel the surgery.

A year later, Brown called Furth with "good news and bad news." The good news was hed found another surgeon to help him. The bad news was the cost was now $10,000.

Although increasingly ambivalent about the surgery, Furth testified, he also felt he couldnt turn down such a rare opportunity. One reason: His good friend Philip Bondy planned to have his own leg cut off as soon as Furth had his done. So when Furth told him the day of the surgery that he was having second thoughts, Bondy "scolded" him, Furth testified, telling him that if he backed out now, "Youll regret this the rest of your life."

But on the taxi ride to the Clinica Santa Isabel, Furth found his attitude changing anyway. By the time he got there, he knew beyond any doubt that he did not want his leg removed. "It was over. It was finished. [My compulsion] had died. I went out and told Brown, Absolutely not."

Thinking perhaps that Furth was merely nervous, Brown offered him a sedative. But, Furth testified, he didnt want to be sedated. He wanted out of there. Before leaving, however, he suggested what he thought would be a win-win solution for everyone. Even though he no longer wanted the operation himself, he knew someone else who did. "Maybe we could switch it around," said Furth. "Philip [could] take my place."

Brown performed the operation on a Saturday morning. Bondy was happy at first, even though, as he would later tell Furth, he had felt Brown "sawing" on his leg. As it was just as illegal to amputate a healthy leg in Mexico as it is in the United States, right after the operation Brown drove 15 miles out into the desert on the old road to Ensenada and threw the leg out the window for the coyotes to eat. Then, before driving Bondy to the National City Holiday Inn, he gave his patient some lessons in walking with crutches. ("He kept falling down, " Brown says in some exasperation. He couldnt seem to grasp the concept of a three-point stance  hed put his remaining foot between the crutch tips, not in front of or behind them.)

By Sunday, Bondy was feeling hungry and dehydrated, and his voice was sounding raspy. Furth, who was staying in an adjoining room, brought him food and water and sat up with him past midnight, talking about the surgery and what it all meant. Around 8 Monday morning, Furth testified, he came back to see what Bondy wanted for breakfast and discovered a "horrible," "traumatic" and "chaotic" scene.

Bondy was lying half on the bed and half off, with blood oozing from a blackened and gangrenous stump. "I saw the phone tipped over," Furth said. "I saw the wheelchair upsided. I saw the sheets pulled out. I touched the top of his head. Rigor mortis had set in. This man did not have a peaceful death."

As the medical examiner determined, Bondy had died from clostridia perfringens (also known as gaseous gangrene), a ã fast-moving flesh-eating bacteria that lowers blood pressure and causes the heart to stop. According to Jack Fisher, the bluntly outspoken UC San Diego plastic surgeon hired by the prosecution to critique Browns medical skills, Brown had failed to leave himself a large enough skin flap to cover the bone and stump. As a result, the skin was stretched too tight for any blood to flow. This killed the flap and allowed clostridia perfringens to feed on the dying flesh.

The photographs of Bondy on his deathbed reminded Stacy Running of an inmate at a concentration camp. "He was very thin, very emaciated. There was not an ounce of excess flesh. The skin on his face followed the skull. The mouth was open. It looked like he was screaming or crying when he died  to God or I dont know whom."

It was clear to Running that Brown had amputated Bondys leg. It was equally clear that Bondy had paid him to do it. The question was why? Then she got a call from Gary Stovall, who was in New York searching Furths apartment.

"I can remember to this day," says Running, a petite, articulate woman with an open, guileless manner that reminds me of Mary Richards from The Mary Tyler Moore Show. "I was working here. Gary calls. Stacy, are you sitting down? Listen to this. And he started reading to me from a piece of literature [on apotemnophilia].

"That was when we first realized what we were dealing with  that Phil Bondy wanted his leg cut off for a reason we couldnt comprehend. We were in shock. And we are people who see the worst that humanity has to offer. We see people do horrible things to their wives, their husbands, their children and their friends. Weve seen just about everything you can see. And then something like this comes up and knocks you for a loop."

Prosecutors have cases where they dont have enough evidence. They have cases where the evidence is contradictory. But rarely do they have a case where the evidence is abundant, bizarre and thoroughly documented on videotape.

When Detective Stovall searched Browns San Ysidro apartment, he found not only bloody shoes, bloody pillows, used needles, silicone vials and two or three dozen empty tubes of Krazy Glue, but bloody towels in the bathtub soaking in bleach, bloody swabs in a travel bag, and dozens of returned advertising brochures (apparently the remnants of a recent mail campaign), which read in part:

The prettiest pussies are John Brown pussies.

The happiest patients are John Brown patients.

Because . . .

1. Each has a sensitive clit.

2. All (99%) get orgasms.

3. Careful skin draping gives a natural appearance.

4. Men love the pretty pussies and the sexy response.

In what turned out to be a lucky break for the prosecution, Brown also owned videotapes of his operations. One of them, entitled "Jack Has a New Pisshole Behind His Balls," had been shot by a friend of the grateful patient and given to Brown as a gift. It showed Brown cutting an opening in Jacks urethra just behind his testicles so Jack could urinate sitting down. "The guy was tattooed from his head to his knees," says Running. "He had big flames coming out of his butthole. Just when you think youve seen it all . . ."

But it was the video of transsexual surgery that most fired up the prosecution against Brown. "Ive seen medical videos before," says Tom Basinski, an investigator in the D.A.s office. "Usually the scalpel slices right in." But Browns scalpel was so dull he had to push hard, saw back and forth. "I said to myself, Oh, my God. This is why this guy has to be stopped."

In the videos opening shot (which is reminiscent of that famous scene from The Crying Game), an attractive Asian girl  Ann, the soon-to-be Las Vegas stripper  is shown standing naked from the waist up, quietly chatting with Brown, who is off camera. She has nicely formed breasts, and abundant black hair that cascades down her shoulders. Then slowly the camera moves down her body  and suddenly you realize she has a penis.

When the actual surgery starts, I find it so unsettling I have to turn off the tape. "All the men had the same reaction," says Running. "The judge asked, Do I have to watch this surgery? I said, Well, yes, you do. Youre the judge."

Apparently Brown intended the tape to be an advertising or training video, as the second scene shows the doctor sitting in a chair, wearing a white coat and explaining the upcoming operation to the camera. "He has a microphone, and his hand is kind of shaking," says Running. "You see him reach up and grab his hand. And this is his dominant hand, the one he operates with. He holds up crude drawings, ripped out of a spiral notebook. He says, This is the corpa . . . the corpa . . . Hes stumped on the word. He finally says it, the capora cavernosa, the spongy tissue on the underside of the penis. He goes on in this vein. You can see him waving [the cameraman] off when he loses a thought. The tape was so crude  you could hear dogs barking during the surgery and music playing. The scrotal skin was lying on a board. It had pushpins in it. It was so dirty and dried out, it looked like it had been run over by a tire."

To Browns critics, in fact, it almost seemed as if he had seen too many Frankenstein movies. "Brown does an operation called an ileum loop," Running tells me, "in which he takes a piece of intestine, leaving it attached to the blood supply, and diverts it to make a vagina. The problem is, your intestines digest food, secrete enzymes, they smell. He almost killed a rebuttal witness in [a prior trial] by doing that to her. He pulls all your guts out on your stomach. Your intestines are connected to your vaginal lining. In many cases he stitches it back to your stomach, and you get peritonitis. He is quite the adventuresome surgeon. He uses human beings for guinea pigs. He is as close to [the Nazi doctor] Josef Mengele as you can get. But I couldnt say that in court. It would have been grounds for a mistrial."

Initially, says Running, the case against Brown "had come in as involuntary manslaughter," but after reviewing the evidence against him, she upgraded the charges to "implied malice murder in the second degree." This applies in cases where the defendant does something that is dangerous to human life, knowing it is dangerous to human life and doing it anyway. But it wasnt enough merely to show that Brown had botched Philip Bondys surgery and then abandoned him in a hotel room. To make the murder charge stick, Running had to demonstrate that Brown had a history of being reckless throughout his career. And to do that, she had to find former patients to testify against him.

They werent easy to come by. Some people told powerful, compelling stories, only to recant them a few weeks later. Some people clearly had hidden agendas. Others told stories that simply didnt jibe with the known facts. On top of this were the large number of women who didnt want it known that they once were men.

When D.A. investigator Basinski, a tall, outgoing former cop with a shaved head and big gray mustache, began calling the people on Browns patient lists, a lot of them just hung up on him. "Some were hookers," he says. "Some thought they were in trouble. Some just didnt like the police. I called one woman, and an older woman answered. Why do you want my son? she said. He committed suicide two weeks ago."

As Basinski later learned, Christina (formerly known as Eddie) had mortgaged her house to pay for a total of 10 surgeries by Brown. But according to legal documents filed by Running, the skin grafts that Brown used to line Christinas vaginal walls were so thin that they tore during intercourse. When Brown removed Christinas lower ribs to give her a narrower and more feminine waist, she subsequently developed an abscess as big as a basketball. Christinas nose job turned out so poorly that she ended up with different-sized nostrils, one of which turned up like that of a pig. Christina complained to Brown that hed made her vaginal entrance too small. But when Brown enlarged it, Christina felt hed "ruined" her.

Today, Brown says he feels badly that he didnt better explain the procedure to Christina. But when he called to tell her he was refunding $500, her mother told him that her son had just hanged himself in the garage. (According to Running, Brown took the news quite calmly, noting merely that "transsexuals had a high suicide rate.")

There was another patient, a genetic female named Mona, who had gone to Brown for breast implants and a face-lift. But Brown, says Running, accidentally cut a nerve in Monas face, leaving her with a crooked smile. Her implants also failed, causing her breasts to rot, turn black and leak a fluid that her boyfriend said smelled like "cat piss." Everything was so bizarre. Sometimes, says Running, when Brown dropped by to inject Mona with pain killers, hed be wearing only one shoe.

Runnings most effective witness, perhaps, was Camille Locke, a bright and forceful woman who at times can be quite contentious. (Basinski says he got so mad at her in an argument over O.J. Simpson that he "wanted to punch her out.") Despite her strong personality, Camille is quite modest in her language and demeanor (when referring to a penis, she demurely calls it a "phallus").

Before her sex-change surgery, Camille had once been an insurance underwriter with clients like Caterpillar and International Harvester. But after surgery, she tells me, she was lucky to find a $5-an-hour job teaching brokers telephone sales.

When Brown did Camilles sex-change surgery in November 1997, the operation took two hours. "He gave me an epidural," says Camille. "I woke up 10 minutes prior to the end of the operation. We started talking. Brown said, Were almost done. I wasnt scared. I was happy as hell. I was finally getting what I wanted. When you are climbing Mount Everest, you dont worry about a little frostbite on the top."

To keep her vaginal opening from growing shut while it healed, Brown gave Camille a phallus-shaped stent made of the same kind of foam used to cushion furniture. "He told me to put a condom on it. I had to hold it in place with little white bra straps. Otherwise it would fall out when I stood up."

After several days, Camille returned to her home in the San Fernando Valley to recuperate. There, to her horror, she developed a recto-vaginal fistula that caused feces to pour out of her vagina. "My bladder was blocked, my lymph glands swelled up and my skin turned yellow," she says. She was hiccuping constantly, unable to stand, and near death. "Black stuff was pouring out of my lungs, all my systems were shutting down. All I would have had to do is take one breath and let go." After five days, a friend found her lying in her own feces and drove her to the ã hospital, where the doctors took one look and said, "What the hell is this?"

The pain was so bad, says Camille, she was screaming at the top of her lungs for 24 hours straight. "They were giving me morphine every 15 minutes. I had an MRI and CAT scan. Six doctors were operating on me simultaneously. I had to have a [temporary] colostomy. They were ready to body-bag and toe-tag me."

Running knew such stories would have enormous impact with a jury  if she could only get the witnesses to court. "We were dealing with people who were very needy, very high-maintenance and sometimes petulant. Many were terrified that the community in which they live and work would find out. Carrie [another witness against Brown] once came to court wearing two wigs, sunglasses and her hair down over her face. "Gary [Stovall] leaned over to me  Your witness looks like a sheepdog."

Defense attorneys have an old saying: When the facts are on your side, argue the facts. When you dont have the facts, argue the law. And when you have neither the facts nor the law, pound the table.

And thats exactly what Browns attorney, Sheldon Sherman, did, says Running: "He slammed his hand on my table at least 17 times. He screamed and slammed his hand, and spittle flew and caught me under my right eye. And he is frothing at the mouth at these God-like doctors who wont let Brown be a part of their club!"

"It was a tough case," says Sherman, a blunt-talking, no-nonsense attorney. "The evidence, facts and the law were all against us."

Having no really good defense options, Sherman chose to portray Brown as a brave and caring man who tended to a segment of society no one cared about. "No one else would deal with transsexuals," he said in his closing argument. "John Brown said, Ill deal with them. Did he do this for money? No. He did it because he cared. And if you dont believe that, then you have my permission  as if you needed it  to find him guilty of murder."

Unfortunately for Brown, after a day of deliberations that is exactly what the jury did.

Sherman, who is planning to appeal the verdict, says he still cant understand how any California court ever got the authority to try Brown for murder. "Brown is guilty of practicing medicine without a license," he says. "I could also go with the notion that he was guilty of manslaughter. But murder? Come on. How does California even get jurisdiction? If you shot someone in Mexico and he died in California, could you be charged with shooting him in California? Of course not. Its the same principle."

Besides, he says, it was never Browns intention to murder anyone. He was trying to help Philip Bondy. "He believed that if you are a consenting adult you should be allowed to do what you want to do. Who is not to say the 48 hours [that Bondy lived after the surgery] werent the happiest 48 hours of his life?"

Browns sentencing is now set for December 17. Given the small latitude open to the judge in such matters, says Sherman, Brown will most likely get 22 years to life.

Which to Gerry McClellan, an investigator for the California medical licensing board who has followed Browns career for nearly 25 years, is very good news indeed. Brown, says McClellan, is one of those people who, because he lives his life almost entirely in his own mind, is impervious to reality. "He has no social conscience. He really believes in what he does. Thats what makes him so dangerous. He is a sociopath, a sincere sociopath. Jail is a momentary hindrance to him. Hes been burned before  he keeps putting his hand on the stove. There is some kind of grander scheme he is fulfilling. I just dont know what it is."

Actually, as Brown tells me in a series of late-night collect calls from prison, it isnt his scheme. Its Gods scheme. And there isnt just one, there are many. In the main scenario, Brown is released from jail, raises money and finishes development of a "hyperthermia chamber" that, he says, will cure cancer, AIDS and genital herpes. As Brown explains it, the patient would be placed in a chamber with an IV drip to replace lost fluid, swathed in bandages and sprayed with hot water to induce a healing fever.

Brown has also developed a prototype of an asphalt removal machine that uses chisels set at a 45-degree angle in a rotating drum, which would cut the cost of such removal from $2 to $4 a linear foot to a mere 50 cents. He has designed an aerodynamic attachment for the rear of trailer trucks that he says will reduce fuel costs by one third. He has plans to write four books: an autobiography based on his medical career; a full explanation of the movement of tectonic plates; a proof of the existence of God based on gaps in evolutionary theory; and most important of all to Brown, a novel about the life of Jesus based on little known facts in the historical record. This last book, which causes Brown to sob whenever he talks about it, will tell the story of what he believes was Jesuss youthful betrothal to Mary Magdalene, his uncles crucifixion in an earlier Roman terror campaign, and Jesuss role in orchestrating his own crucifixion.

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In the meantime, Brown is pursuing what he calls the "Doc Holliday" scenario. Before he was arrested, Brown had written to a dozen states, asking if they would consider giving him a license if he would agree to work as a general practitioner in some small rural setting without a resident physician.

The problem at the moment, of course, is that hes locked up in jail. But even that, Brown believes, is not necessarily an insurmountable obstacle. After he lost his license in 1977, he says, he went to live on a 550-acre Mexican ranch. As he was walking up a hill one night carrying a kerosene lantern, God spoke to him, clearly and distinctly. "Words started pushing into my mind," says Brown. "The words kept coming up for two days. The message began, Why do you kick against the traces? It went on: You should know that the details of your life have been arranged so that you would be where you are now, doing what you are doing. I knew that meant working with the transsexuals. It went on: What you are doing is appreciated, because these are my children, too."

By the time the conversation was over, says Brown, he knew hed been given a mission  to take care of the surgical needs of Gods "children," the transsexuals, for the next 20 years. Now, he says, God is guiding his steps again, this time to finish his hyperthermia chamber for curing congenital AIDS. In case He forgets, says Brown, every day he "reminds" God of the "special program I plan for AIDS babies, and I pray every night He will release me soon."

But if God has some other plan for him, Brown says, "Ill be content to be here as long as He wants me here."